The Rise Of Nursing Home Litigation: Findings From A National Survey Of Attorneys

Stevenson, David G.; Studdert, David M.

doi:10.1377/hlthaff.22.2.219

Cited by 56 publications

(37 citation statements)

References 5 publications

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“…Most studies argue that ‘an uneasiness with discussion and reporting of errors’ in nursing homes in the USA is an important cause of the poor PSC 9 13. This uneasiness and the related policies and processes may be a reaction of US nursing home management to the tremendous rising costs of litigation because of the increasing number and severity of lawsuits connected to patient safety in nursing homes 26. Such a legal claim culture is absent in the Dutch healthcare system.…”

Section: Discussionmentioning

confidence: 99%

Safety culture in long-term care: a cross-sectional analysis of the Safety Attitudes Questionnaire in nursing and residential homes in the Netherlands

2015

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Objective The first objective was to investigate if the Safety Attitudes Questionnaire (SAQ) is appropriate to measure the safety attitude of caregivers in nursing and residential homes, and second, to compare safety attitude of these caregivers with available data of caregivers in other settings (ie, inpatients, intensive care unit (ICU) and ambulatory care). Methods Using a cross-sectional survey methodology, we obtained completed SAQ surveys from 521 caregivers (response rate of 53%) working in nine units in nine different nursing and residential homes in The Netherlands. Exploratory factor and Cronbach's alpha measures were used to analyse the psychometric properties of the SAQ. A correlation matrix was performed to study the relationship among the SAQ dimensions. A t test was performed to test significant differences between our sample and the benchmark settings. Results The factor analyses and calculated Cronbach's alphas (α=0.56-0.80) for this sample confirmed the robustness of the SAQ scales. There was a high positive correlation between teamwork climate, job satisfaction, perceptions of management, safety climate and working conditions (r=0.31 to 63), but stress recognition had a negative correlation with each of the other dimensions (r=−0.13 to −0.18). Overall, the scores from the nursing and residential homes differed significantly from the benchmark settings. Conclusions The findings in this study confirmed that the SAQ could also be used in the nursing and residential homes setting. However, stress recognition in nursing and residential homes setting does not seem to be one of the dimensions of the safety attitude construct. Furthermore, Dutch nursing and residential homes have significantly higher scores on most dimensions of the SAQ compared with US inpatient units and comparable scores to ICUs (Dutch and US) and ambulatory services.

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Section: Discussionmentioning

confidence: 99%

Safety culture in long-term care: a cross-sectional analysis of the Safety Attitudes Questionnaire in nursing and residential homes in the Netherlands

2015

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“…A recent national study showed that only 17% of nursing homes reported special program trained staff for palliative/end-of-life care, and only 19% reported such staff training for hospice care 38 . Furthermore, it appears that law suits against nursing homes, largely by residents’ family members, represent the fastest growing area of healthcare litigations 39 . Perhaps as a result, nursing home physicians and facilities concerned with liability issues 31 may have become increasingly more inclined to hospitalize residents at the end-of-life, thus increasing the likelihood of inhospital death.…”

Section: Discussionmentioning

confidence: 99%

Site of Death Among Nursing Home Residents in the United States: Changing Patterns, 2003–2007

Temkin‐Greener

Zheng

Xing

et al. 2013

Journal of the American Medical Directors Association

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Context The proportion of US deaths occurring in nursing homes (NHs) has been increasing in the last two decades and is expected to reach 40% by 2020. Despite being recognized as an important setting in the provision of end-of-life care (EOL), little is known about the quality of care provided to dying NH residents. There has been some, but largely anecdotal evidence suggesting that many US NHs transfer dying residents to hospitals, in part to avoid incurring the cost of providing intensive on-site care, and in part because they lack resources to appropriately serve the dying residents. We assessed longitudinal trends and geographic variations in place of death among NH residents, and examined the association between residents’ characteristics, treatment preferences, and the probability of dying in hospitals. Methods We used the Minimum Data Set (NH assessment records), Medicare denominator (eligibility) file, and Medicare inpatient and hospice claims to identify decedent NH residents. In CY2003–2007, there were 2,992,261 Medicare eligible nursing home decedents from 16,872 US Medicare and/or Medicaid certified NHs. Our outcome of interest was death in NH or in a hospital. The analytical strategy included descriptive analyses and multiple logistic regression models, with facility fixed effects, to examine risk-adjusted temporal trends in place of death. Findings Slightly over 20% of decedent NH residents died in hospitals each year. Controlling for individual level risk factors and for facility fixed effects, the likelihood of residents dying in hospitals has increased significantly each year between 2003 through 2007. Conclusions This study fills a significant gap in the current literature on EOL care in US nursing homes by identifying frequent facility-to-hospital transfers and an increasing trend of in-hospital deaths. These findings suggest a need to rethink how best to provide care to EOL nursing home residents.

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“…If particularly ill patients refuse hospitalization, mortality may increase. Providing care to more acutely ill patients in nursing homes ill prepared to do so may take time away from other residents, increasing the potential for adverse events and litigation (Stevenson and Studdert 2003). Absence of a bed-hold policy may prolong hospitalization due to difficulty in determining a locale for hospital discharge (Nohlgren 2004).…”

Section: Discussionmentioning

confidence: 99%

Maintaining Continuity of Care for Nursing Home Residents: Effect of States' Medicaid Bed‐Hold Policies and Reimbursement Rates

Intrator¹,

Schleinitz²,

Grabowski³

et al. 2009

Health Services Research

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Objective Recent public concern in response to states’ intended repeal of Medicaid bed-hold policies and report of the association of bed-hold policies with higher hospitalization rates prompts examination of these policies in ensuring continuity of care within the broader context of Medicaid policies. Data Sources/ Study Design Minimum Data Set (MDS) assessments of long-stay nursing home residents in April–June 2000 were linked to Medicare claims enabled tracking residents’ hospitalizations during the ensuing 5 months and determining hospital discharge destination. Multinomial multilevel models estimated the effect of state policies on discharge destination controlling for resident, hospitalization, nursing home and market characteristics. Results Among 77,955 hospitalizations, only 5,797 (7.4%) were not discharge to the baseline nursing home. Bed-hold policies were associated with lower odds of transfer to another nursing home (AOR=0.55, 95%CI 0.52–0.58), translating to 9.5 fewer nursing home transfers and 77.9 more hospitalizations per 1,000 residents annually, and costing Medicaid programs about $201,311 more than otherwise. Higher Medicaid reimbursement rates were associated with lower odds of transfer. Conclusions Bed-hold policies were associated with greater continuity of NH care, however their high cost compared to their small impact on transfer but large impact on increased hospitalizations suggest they may not be effective.

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The Rise Of Nursing Home Litigation: Findings From A National Survey Of Attorneys

Cited by 56 publications

References 5 publications

Safety culture in long-term care: a cross-sectional analysis of the Safety Attitudes Questionnaire in nursing and residential homes in the Netherlands

Safety culture in long-term care: a cross-sectional analysis of the Safety Attitudes Questionnaire in nursing and residential homes in the Netherlands

Site of Death Among Nursing Home Residents in the United States: Changing Patterns, 2003–2007

Maintaining Continuity of Care for Nursing Home Residents: Effect of States' Medicaid Bed‐Hold Policies and Reimbursement Rates

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